Pressure Wraps for Anxiety in Dogs

Here is another excellent, informative post from contributing author and dog trainer Kyzyl.

Pressure Wraps for Anxiety and Fearful Behavior

Fear is a set of evolutionarily important behaviors for animals. Fear often keeps animals alive in a dangerous world by teaching them to avoid things that could bring about their untimely end.However, when fearfulness runs out of control or is coupled with common, innocuous events, it can become a serious behavior problem for pets and their owners.Whether it is associated with specific triggers, such as car rides, thunderstorms, and veterinary visits, or generalized,excessive anxiety and fearfulness can intensify to the point where normal functioning becomes impossible, and pets can act out in extreme ways including aggressively, urinating and defecating on themselves, or shutting down completely when forced into situations that trigger fear.

If your dog has moderate or severe problems with fear, there are a limited number of treatments to help alleviate anxiety including behavior modification and drug therapy. Behavior modification, when done effectively, is very successful at alleviating considerable amounts of stress due to specific stimuli. Behavior modification plans for fearful dogs often consist of two techniques: counter conditioning and systematic desensitization. These techniques change behavior by changing the underlying emotional state of the dog, therefore relieving the stress and anxiety of the fear-based behavior (8). In severe cases, vets might also prescribe a sedative to help with specific situations like grooming or veterinary visits or general anxiety or an anti-anxiety medication to reduce fear enough to improve the patient’s quality of life and allow behavior modification a chance to work.

However, behavior modification techniques are often very difficult for owners to execute correctly. Behavior modification tools require training skill and time, neither or which average owners can often provide.And many owners are also very reluctant to medicate their pets for behavior problems.

As a result, many owners and trainers have turned to alternative therapies that promise great results for treating phobic behavior, one of which is pressure wraps. Commercial pressure wraps (the Anxiety Wrap® and the ThundershirtTM) use elastic fabric and velcro to create a tight-fitting garment that is worn during anxiety-causing events.When fitted properly, the garment creates distributed pressure over the chest, sides, and back that supposedly has a calming effect.

How do they work? According to the ThundershirtTM website, several reasons were listed as evidence for why the product’s gentle pressure worked to calm anxious behavior (10).These include a reference to people with autism using pressure to relieve anxiety, swaddling as a method of calming upset babies, acupressure, and TTouch practitioners using pressure to address anxiety. These are not high-quality sources of evidence, but interesting ideas to consider none the less.

While there is little research on touch and pressure therapies in dogs, the effects of these therapies have been studied in humans and other mammals. Touch is critical for normal development of infant rats and humans and profoundly affects our social interactions (1,2,9). We know that touch, especially deep touch such as a hug, releases endorphins that promote relief from pain and a sense of well-being and self-reported improvement of symptoms of compulsive disorders and depression in humans(1,2).

Massage has long been used to successfully address issues with musculoskeletal pain, but when used to treat anxiety in people results have been both positive and negative leading to an inconclusive answer on whether or not it is useful treatment for anxiety (1,3,4,5).

Knowing that generally pressure and touch have effects on people, and by extension pets, makes evaluating claims of specific systems that employ it very difficult. Firstly, since general touching provides many of the benefits claimed through the system, it may be that the specific motions, actions, or places suggested by different systems of touching are not as important as the act of touching itself.Without controlling for these general effects, one can never be sure if positive results are due to the general effects or more specific effects of the system’s protocol.

Other modalities supporting pressure for anxiety relief, such as acupressure and Tellington TTouch®, have very little supporting evidence. Acupressure, a variation on acupuncture where acu-points are pressed to influence the flow of qi, has been addressed several times on this blog (12).In the great majority of cases, it has no specific effect beyond placebo or sham treatments.Tellington TTouch® combines specific touches with exercises in order to, as its website claims, “activate the function of cells and awaken cellular intelligence” (16).(Though anxiety and fear may be a big problem for a dog, I doubt it has much to do with how ‘intelligent’ its cells are.)Despite the complicated protocols and mystical thinking called for by both, no evidence these modalities work beyond the general effects of touching.

The effects of touch seem to be best studied in systems with human contact, touch by a human, and there is no reason to think that touching by inanimate objects would have the same effects. A supporting example referenced on the ThundershirtTM website illustrates this: swaddling babies.Is it the tight wrapping that calms the child, or the warm touch of its mother?These claims should be evaluated separately to determine the effectiveness of a pressure wrap.

What is the specific evidence for pressure wraps? People with autism report anecdotally feeling at ease when experiencing pressure from inanimate objects. Dr. Temple Grandin, who is referenced on the ThundershirtTM website (10), developed a hugging machine to help her through anxiety related to autism..This machine allowed the user to control the duration and intensity of pressure applied to his or her body.In preliminary, uncontrolled trials, both autistic and neurotypical people suffering from anxiety self-reported improvement (6).Despite initial research being promising, this hypothesis has garnered little support in the scientific literature over the past decade.

However, there are major differences between the hug machine and pressure wraps which are meant to reproduce its calming effects. Pressure wraps apply a constant pressure not under user control. Also, pressure wraps likely do not produce the same type of deep pressure as the machine.A pressure wrap, similar to those for dogs, was developed for autistic children seeking to replicate the effects of the machine have not had success in relieving anxiety in stressful situations (ref).

Several professionals report success in the ‘testimonial’ section of the products’ websites (10), reporting dramatic and immediate improvement of anxious and fearful behavior in dogs wearing these wraps. They both make fantastic claims that their wraps can correct problems ranging from behaviors associated with phobias to pulling on leash during walks, with very little cited research or concrete numbers to back up these claims.

While these anecdotal reports from professionals certainly justify interest in conducting trials, they do not necessarily support the confident claims made on the product websites. The problem with anecdotes is that they often only tell the story we want to hear, they don’t describe the truth of a situation.Humans have very selective memories, often remembering only the details that support a line of thought (conformation bias: 14,15), so that details or cases that don’t support the thought are forgotten or neglected.Furthermore, companies have great financial motivation to only share extremely successful cases and ignore all the wraps they sold that didn’t work as advertised.Customers reports in which the wraps didn’t work don’t often make it to the ‘testimonial‘ page, but plenty have shown up in product review pages for third party sites such as Amazon.com, in which 30-40% of reviewers said that the Thundershirt had little or no effect on their dog’s anxiety(11).

Strong evidence for the effectiveness of pressure wraps would come from trials looking at the effect of pressure wraps compared to controls for each of the behavior problems listed. I was unable to find any controlled trials that test for efficacy of pressure wraps for any dog behavior problems, much less the long list of problems each product’s website claimed to solve. (If you should know of any trials, please let me know.)Other than one clinical trial still enrolling at Tufts University’s Veterinary School (13), I have found no evidence that either company has attempted to at all test the claims they make for their pressure wraps for dog behavior problems.

So maybe pressure wraps work, and maybe they don’t. If they don’t hurt, why not try them out? The biggest concerning of using a pressure wrap is one of the more dangerous aspects of using alternative therapies: giving up on conventional treatments that do work. On its website, the ThundershirtTM insists that no training is needed for these wraps to work, simply strap it on and all the behavior problems lessen or go away.By not engaging in behavior modification, particularly systematic desensitization, the emotional state causing fearful or anxious behavior will never be addressed.And for this training to work, often times medication must be used to lessen anxiety to a manageable level.Much like putting a bandaid on an infected sore, simply using the pressure wrap may only serve to mask visible symptoms without curing the underlying infection.With no real treatment, a pet could continue to quietly suffer from fear or anxiety.

In conclusion, I find no high-quality evidence that pressure wraps, such as the Anxiety Wrap® or ThundershirtTM, help or correct behavior problems including those associated with anxiety or fearfulness.Their principle idea, that distributed pressure calms the nervous system and relieves behavior problems in dogs, remains an intriguing, yet unsupported, hypothesis.While pressure wraps are most likely safe to use, they should not be considered a replacement for more conventional treatments such as behavior modification and drug therapy.

7. LaChappelle, R. 2009. Use of a Pressure Vest to Reduce the Physiological Arousal of People with Profound Intellectual and Physical Disabilities During Routine Nail Care. Thesis. Dept of Occupational Therapy, East Carolina Univ.

what about that one? My own preference would be for not putting members of non-human species in situations where they have to conform their behaviour to human exigencies, but given that it’s difficult, I suppose anything that isn’t downright violent is an improvement on anything that is. ADD in horses, with corresponding medication, though? Hmmmmm.

Surprising as it may sound to you, my dogs have benefited from wearing their Thundershirts for road noise in the car, for fireworks, for thunderstorms, pre-trial at agility competition, and for visiting the vet for rabies vacinations. I have rat terriers and a wire-haired dachshund.

Please note that Thundershirt is not 100% effective for all dogs. That is why there is a money-back guarantee if the buyer is not happy with the purchase.

No, I am not paid to endorse Thundershirt. I simply am a satisfied customer.

I’m glad your pets have done well with this product. Unfortunately, there are many possible explanations other than a true therapeutic effect for the thundershirt, so such anecdotes don’t help us a lot in evaluating medical treatments, which is why clinical trials are so important. Still, thanks for the input.

Thank you for the article. I’ve tried anxiety wraps on 3 dogs, each of whom became even more stressed. I once mentioned this amongst a group of trainers and also pointed out that there is no evidence to support the use of anxiety wraps. Boy did I get flamed.

Excellent article. I agree that they’re at least worth a try. If they don’t work, then they don’t work. But if they do, then fantastic!

I’ve seen the Thundershirt work what seems like miracles for some dogs and do nothing for other dogs.

Dogs don’t usually go around touching each like humans do (example, many dogs don’t enjoy hugs and perceive them as a threatening behavior) so why something like this may work for humans probably won’t pertain to dogs.

However, I have a theory of why these pressure wraps may work for some dogs. It can fool them into thinking that they’re being protected. Just like a dog that will hide under the furniture so they have protection, the pressure wrap can create an illusion of this. A shield of sorts.

We have the wraps for sale in our vet clininc but I do always stress to people I cannot state clearly if they work or not (as a result, we don’t really sell very much). Some clients insist it works, others say it made no difference. I have trialed it on my own anxious dog but I cannot notice any difference.
We do find it very frustrating that people are reluctant to use anti-anxiety medication. Anxiety is a recognised medical condition, people wouldn’t deny their pet medication for other recognised medical conditions such as diabetes, thyroid issues etc, yet they are really reticent to use anti-anxiety medication.
People need to recognise that there is a difference between behaviour problems and problem behaviour. One is a training issue, the other has nothing to do with training and everything to do with a medical propblem of some kind, be it thyroid, diabetes, arthritis or anxiety.

Music therapy appears to be quite useful for calming dogs in stressful situations. Several individuals have developed specialized music programs and they have been tested fairly extensively in kennels, dog care sites, and in homes. The result are generally positive in terms of music having a calming influence. One can “google” music therapy for dogs and several names come up. Lisa Spector of “Through a Dog’s Ear” appears to have done extensive background work developing her program. In some situations this type of approach could supplant either drugs or complicated behavior modification protocols that are difficult for owners to follow.

I own a pet supply store and have sold possibly hundreds of these Thundershirts. It’s true that for some dogs it doesn’t help, but the majority have amazing stories of its success. If there’s anything I know, it’s that people return what doesn’t work, and we encourage them to do so. We get very few back. We’ve seen instant transformations in the store in dogs that were trembling and panting, trying on the Thundershirt, and relaxing instantly, able to look around and the tail starts to wag. It’s a lovely thing to see, and we know the shirt isn’t going to hurt anyone. We always pair the sale with training advice for how to continue to help the dog with things like counter-conditioning, but the truth is that often this shirt helps dogs. Nothing helps every dog, but this is a nice tool to try.

Amazing stories are very convincing, but I’ve heard amazing stories about every therapy every tried, including those like bloodletting which we now know do more harm than good. The hardest thing about science is that it requires us to accept that things aren’t always what they seem. To say we know something is safe and effective based only on uncontrolle individual anecdotes either means everything works, or it means anecdotes aren’t very reliable.

Thanks so much for your article. I’m a member of a few dog discussion forums and when I heard about this thundershirt I actually burst out laughing (oops). The amount of junk that gets passed around these communities is boggling to the mind e.g. the raw meat diet (i.e. the evolutionary diet argument. “Don’t feed your dog starch because they can’t digest it and wolves don’t eat it”- a claim undeniably opposed by a recent study in Nature http://www.nature.com/nature/journal/vaop/ncurrent/full/nature11837.html).

Explaining to people what confirmation bias is and outlining all the different ways humans can deceive themselves through their expectations (etc.) just doesn’t seem to sway many people away from their positive personal experiences (evidently, from the comments above). It’s interesting to me that amazing claims of something’s efficacy raises a red flag for some and optimistic excitement for others. I wish I knew how to convince others that opinions should be based on the current research out there.

As of 9/30/2013, the current ratings on Amazon are considerably different from the the “30%-40%” negative experiences stated in your article. The product currently has a positive rating of 4 out of 5 stars out of 1500 reviewers, with only about 20% noting little to no effect on their dog. Dissatisfied customers are usually more vocal on public ‘testimonial’ pages such as Amazon’s, jus sayin.

“Customers reports in which the wraps didn’t work don’t often make it to the ‘testimonial‘ page, but plenty have shown up in product review pages for third party sites such as Amazon.com, in which 30-40% of reviewers said that the Thundershirt had little or no effect on their dog’s anxiety(11).”

The author of this post (which was a guest author) likely surveyed the Amazon reviews at the time of writing, which was 2 1/2 years ago. Likely the numbers have changed. Obviously, amazon reviews are not the way to evaluate the effectiveness of any therapeutic device, whether they are positive or negative and, as the author pointed out, people who think the product did nothing are a lot less likely to write a review than people who think it helped or hurt their pet. In the absence of real data, we cannot yet conlcude whether this product is effective or not.

Amazon is the last place (among hundreds of other product “review” sites) I would ever trust a review. You know what they say, he who speaks loudest….just look at pseudoscience book reviews for example.

When I took the canine behavior course offered by Wolf Park in Battleground, Indiana – a wolf study institute founded by a behaviorist from Purdue University – they explained that they used firm rhythmic stroking along the sides and back of the wolves to relax them for veterinary work. The explanation was that such stroking, crossing the neural dermatomes (which are real anatomical structures – not woo), resulted in the release of endorphins. I have used this technique, also applied to ear, head and neck massage, to calm dogs in stressful situations. If you can addict the dog to the rewards produced by massage from your hands you have a great tool for behavioral modification. Stressed dogs often develop stress anorexia so the attempts to reward calm behavior in a stressed dog with food will fail. Reducing stress reactions seems to work best if you can intervene before the animal flips into full panic mode.

Although I have not tried a such things as a Thundershirt, it could be that some of the success could be that it restricts frantic activity and thus allows some desensitization
to occur. I wonder if a mechanical “massage shirt” might work even better.

In addition there is possibility that the owner expects it to work and so the owner is less anxious and this lack of anxiety is picked up by the dog. Many dogs do react to their owner’s moods and behavioral placebos could work through this mechanism.

Dogs use hugging (in the form of dominance “humping” independent of sexual activity) as a form of dominance. In my experience dogs that do not like to be hugged are reacting to the situation where the human’s action is a dominance action. Dominant dogs will accept hugs from people that they respect as leaders but can react in a dangerous manner to humans who the dog thinks it is dominant over. This can include giving a disciplinary bite to the human attempting the hug.

My dogs in general are not afraid of loud noises but one night we had lightening strike that split large tree next to the house and that generation of dogs instantly became afraid of lightening. Many of the individuals who experienced the lightening stike were less panicked when outside in their dog houses than they were when indoors.

On the other hand some of our dogs that came from places with tornadic storms really want to be inside as severe weather fronts approach. Mostly these dogs go into the various crates that are scattered through the house.

Blog posts on the internet live on forever. So here is the most recent research on this subject:
King, C., Buffington, L., Smith, T.J., Grandin, T. (2014) The effect of a pressure wrap (ThunderShirt®) on heart rate and behavior in canines diagnosed with anxiety disorder. Journal of Veterinary Behavior: Clinical Applications and Research

Thanks for the link! It is an interesting paper which, as with all good science, raises as many questions as it answers. The results indicate lower heart rates in dogs with the Thundershirt employed as intended overall compared with a loosely fit shirt or no shirt, though not all differences in heart rate were significant between treatments when particular subgroups were looked at (dogs on anti-anxiety meds and dogs not, for example). There were no significant differences in behavioral measures of anxiety.

The study was randomized, but there did appear to be some potentially confounding differences between groups. For example, the proportion of males was considerably higher in Group 2 than in the other groups, and the proportion of subjects on meds for anxiety was quite a bit higher in Group 1 than in the other groups, though we can only speculate on what, if any, effect these imbalances might have had on the results.

It is not clear how much absolute difference there was in heart rate since the values aren’t given, and of course the specific numbers would be influenced by size and other factors. So it is not clear how one would decide if the absolute differences were clinically meaningful even though statistically different, especially given the absence of any apart differences in behaviors measured.

It is also a bit of a question the degree to which heart rate can be consistently viewed as a reliable proxy marker for anxiety. Heart rate typically rises during stress, but there is a great deal of individual variability, and heart rate can rise during positive experiences (eustress, e.g. sexual arousal) as well as negative experiences (distress, e.g. startle response). It is reasonable to use heart rate as a proxy as long as it is consistent with other markers, but in this study it appeared to be the only significant difference, so it may not be measuring what we are really interested in.

And, of course, we must bear in mind that the study was not blinded, so owners and researchers were aware of the treatment the dogs received, which could potentially have affected the behavior of the humans towards the dogs, thus affecting the dogs’ responses (for example, as was seen in this study of drug detection dogs). This would be a particular concern if subjective assessments of behavior sowed a treatment effect, though that wasn’t the case in this study, but it might still be a factor influencing differences between groups.

Finally, this was obviously an artificial test situation. This has the advantage of making it easier to compare subjects and treatments as there are fewer variables uncontrolled. It also has the disadvantage, however, of making it harder to generalize results to a real-world context.

In any case, it is nice to see some formal, controlled research applied to the use of this product, and it will be interesting to see if a consistent body of evidence develops to show a beneficial effect. It would certainly be wonderful to have a safe and effective therapy for anxiety disorders in dogs since current therapies are unpredictable and not often dramatically or consistently effective. Thanks again!

In the King et al. article, the mean HR values are provided in the accompanying figures. So, in the first of the four HR comparisons, the dogs wearing the pressure wrap to specs showed ~7 bmp decrease in HR. Dogs not wearing the pressure wrap, or not wearing it to specs, showed ~20 bmp increase in HR. A similar pattern was evident when only those dogs not on anxiety medication were considered.

Yes, I see where you can estimate the mean heart rates for the groups (adjusted for age). There is certainly a large absolute difference, which supports the idea of a clinically meaningful change. Still, it is a bit strange data. The heart rates for all groups are extremely high, even compared to a situation at least as anxiety inducing like being in an exam room at a vet hospital. I rarely see heart rates pushing 160 in even anxious healthy dogs, so that makes one wonder about the representativeness of the population and context.

Of cours,e again one wonders whether the change represents a true reduction in anxiety or some physiological reflex associated with the treatment. Interesting, anyway.

I purchased a Thunder Shirt for my 9 year old Shih Tzu 4 years ago, and it works great for him.. He has separation anxiety and fear of thunderstorms.. I also purchased the CD, “Through a Dogs Ear”.. I know all dogs don’t react the same to this product but it’s been a lifesaver for Baxter..

I have 2 Shelties and a Pom. The youngest Sheltie has serious anxiety during storms and her pacing causes the other two to become stressed. I put on the Thundershirt at the first sign of a storm today and she is not only calm, so are the other two. Don’t know about other dogs, but Ginger seems to respond very well.

Interesting post. When I adopted my dog, she had terrible anxiety during thunderstorms. Shaking, drooling, vomiting, nervous diarrhea, etc. It was so bad that I took her to the vet for medication to at least take the edge off enough to be able to start behavior modification. Tried one medication for a while, which did nothing to remotely improve the anxiety during storms, then tried another medication which also did nothing.. then they increased the dosage a time or two and that still did nothing. It had been about a year and half of this poor dog losing her marbles during Tstorms and at the same intensity as when I first got her, when I decided to try the Anxiety Wrap as a last effort. I had no expectations for it, and per directions I put it on her off and on during non-Tstorm times for weeks so she would not associate wearing it with storms. The first two times she wore it, no change. She went and hid and did her drooling, vomiting, everything. The third time, however, I was watching a movie during the storm and some time into the storm, I looked down and my dog was on the floor ASLEEP. I could not believe my eyes. Thereafter, her reactions during Tstorms were so much dramatically better – not always comfortable enough to fall asleep, but minimized to only some shaking. I realize that there are other factors that I may not be accounting for and that anecdotal stories prove nothing, but I am still rather amazed by that product. I never really changed my behavior – during Tstorms I just sat and watch tv, didn’t bother her and let her do whatever she is going to do. I have heard that the wraps cover a lot of the dog’s coat and that helps prevent them from feeling as much static charge in the air during storms. I doubt it has any effect on their ability to sense changes in barometric pressure, but I am pretty certain mine feels the change. I have a “thunder glass” barometric pressure gauge on my wall and whenever my dog starts acting nervous for no reason, it prompts me to go look at it and sure enough, when that thing shows a big drop in pressure it almost always coincides with my dog acting nervous, looking at windows, and seeking safe spots. My dog is a more reliable predictor of the severity of incoming storms a day or two in advance than my phone’s weather app 🙂
Anyhow, love your blog. Thank you!

So appreciate your blog and your guest blogger for this article! Is Kyzyl on Twitter? I’d like to follow.

It would be great if you (and Kyzyl) could tweet more and respond to tweets linking to bogus articles and poorly conducted research. I’m consistently shocked by the tweeting of Dr. Karen Becker’s articles. I hope that people do not confuse her with Dr. Marty Becker!

The first time I read an article I thought, “I can’t believe Dr. Becker is saying this.” Then I looked further and saw the first name, and it made sense, but it was tweeted by someone who had formally tweeted her own science-based articles on dog behavior, so I was initially fooled believing that it was a trusted source. What is worse than someone who always tweets cha-cha is someone who tweets good with bad info.

It seems more and more “questionable” information is being disseminate via twitter to the general public by “experts.” It’s disheartening. When the experts are RTing without challenging it comes across as an endorsement.

I wonder sometimes if scientists feel (or are directed) that they must always support other scientists regardless of the methodology and lack of replication/validation? Or maybe they don’t know how to respond diplomatically without feeling they’re being adversarial? I’ve seen a very few do it, though, so it is possible, and I think responsible. Bad info is sometimes propagated by scientists or “professors;” for the welfare of dogs, cats, and animals in general, it should be challenged.

“This scientific paper says that dogs can understand language!” RT!

“This study showed dogs prefer petting over food!” RT!

Science is not always good.

But I digress! 🙂

Kyzyl mentioned swaddling. Is there any research supporting it? Dr. Karp, who invented the Snoo baby bed, seems to believe swaddling is an important aspect of babies calming and sleeping, but I see no scientific references in any of the published reports for the public.

(I removed the links because I received a message that my post seemed “spammy.”)

Also, what are your thoughts about the recent research about guide dogs being failures if they’re coddled by their moms?

“The relationship hints strongly at the role a mother’s behaviour plays in determining the cognitive and social abilities of her young. A little stress, it seems, could give the growing pups the edge over their peers.
It’s important to note that studies such as these can make it hard to distinguish genetics from the influence of their mother.”

Thank you so much! There are so many anecdotal stories about these products (and everything dog related) online, which as you point out, does not constitute evidence. I sincerely appreciate such a considered post. You are doing great work, it’s often difficult to seperate marketing from real science when dealing with a pup with behavioural issues and I’m so glad to see someone working to address this.